Project Summary/ Abstract Proposed Objective: As an evaluation of a state-sponsored overdose education and naloxone distribution (OEND) program, this research proposal, the INPEDE OD - Intranasal Naloxone and Prevention EDucation's Effect on OverDose - Study, responds to two research objectives of NCIPC/CDC RFA-CE-09-004: Unintentional poisoning from prescription drug overdoses in adults. First, the study will evaluate a program that provides naloxone as an antidote to persons at high risk for overdose (Research Objective #5). Second, it is research that can inform the ongoing policy debate on prescription drug overdose prevention through secondary data analysis in a state that will assess the health impact of a state's new overdose prevention program (Research Objective #7). Importance: Findings from this study will contribute to the scientific base for public health agencies and community organizations who are seeking novel approaches to address unintentional poisonings from drug overdose. Because the study is conducted in partnership with the Massachusetts Department of Public Health (MDPH) and it evaluates an MDPH-supported OEND program, this study will have direct and immediate impact on the implementation of this program in Massachusetts. Study Objectives: Specific Aim: Determine the impact of opioid overdose education with intranasal naloxone distribution (OEND) programs on fatal and non-fatal opioid overdose rates. Hypotheses: 1. Among Massachusetts communities with high burdens of fatal opioid overdose, the implementation of OEND programs from 2006 to 2009 is associated with decreased rates of fatal opioid overdose. 2. Among Massachusetts communities with high burdens of non-fatal opioid overdose, the implementation of OEND programs from 2006 to 2009 is associated with decreased rates of non-fatal opioid overdose. Study Design: Quasi-experimental interrupted time series comparison. Setting: Commonwealth of Massachusetts Participants: 18 communities in Massachusetts with 5 or more fatal opioid overdoses annually. Intervention: Massachusetts OEND program that includes distribution of intranasal naloxone among potential overdose bystanders, including needle exchange participants, clients of HIV/AIDS education and prevention programs, clients of substance abuse treatment programs, friends and family of people at high risk for overdose, and professionals working in substance abuse treatment and social services organizations. Outcome Measures: Change in annual fatal and non-fatal opioid overdose rates in communities in the Commonwealth of Massachusetts with high burden of opioid overdose. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE One novel approach to opioid overdose prevention is overdose education with naloxone distribution (OEND) programs. Among 18 Massachusetts communities with high numbers of opioid overdoses, the proposed INPEDE OD - Intranasal Naloxone and Prevention EDucation's Effect on OverDose - Study will determine the impact of OEND programs using an interrupted time series analysis to examine changes in annual fatal and non-fatal overdose rates over the period from 2002 and 2009 in those communities where an OEND program was implemented compared to those communities where it was not. The results of this study will be directly relevant to the overdose reduction efforts of public health entities nationwide.